Date of Award

2016

Document Type

Honors Thesis (Open Access)

Department

Colby College. Philosophy Dept.

Advisor(s)

Lydia Moland

Second Advisor

Paul Berkner

Abstract

In the United States today 20% of all Americans die in Intensive Care Units, or ICUs. These were developed in the 50s, 60s, and 70s to centralize medical resources to help treat critically ill patients with new technologies like ventilators, dialysis, and other tools that are now commonplace. This occurred simultaneously with the emergence of individualistic autonomy, understood as the patient's right to dictate their treatment, as the dominant force in medical ethics. Ostensibly both of these developments would seem beneficial for patients. However, the ultimate result is overly aggressive care that strips patients of their dignity and ensures that the last moments of their lives are spent in pain. This thesis seeks to demonstrate that autonomy as it is currently instantiated is failing to protect patients adequately, and as expressed by O'Neill a more principled--Kantian--version of autonomy is sorely needed to replace the individualistic autonomy. This can be achieved through a principle of "Don't Know, Do Not Resuscitate," based on the moral epistemological work of Guerrero combined with Korsgaard's restatement of the moral philosophy of Kant, which argues for greater caution in the face of moral and empirical uncertainty to avoid the risk of treating a patient as a means rather than an end in themselves. This risk is present because often during the stress of end-of-life decision making physicians and family members may opt for more aggressive treatment for reasons that do not necessarily protect the best interest of the patient and instead serve to allay fears of loss, 'giving-up,' and other such emotions. The goal is to promote what Kant called a "Kingdom of Ends" in the ICU through suggesting caution before aggressive intervention to protect patient autonomy.

Keywords

Bioethics, Kant, Korsgaard, End-of-Life Care, Moral Epistemology, Critical Care

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